Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2011
ReviewManagement of postdischarge nausea and vomiting after ambulatory surgery.
Although there are extensive studies of postoperative and postdischarge nausea and vomiting (PONV/PDNV) up to 24 h, few investigate 'delayed PDNV'. With an increasing outpatient surgical population, specific 'delayed PDNV' risk identification and management is necessary for improving outcomes and helping patients after discharge. This review will discuss possible PDNV specific risk factors, successful prevention and management of PDNV following ambulatory anesthesia and the principles and pharmacology of these interventions. ⋯ Further PDNV specific research is needed, including PDNV predictive models in directing antiemetic interventions. Long-acting antiemetics and postdischarge oral antiemetics are effective in PDNV pharmacologic management. Neurokinin-1 receptor antagonists are effective in reducing the incidence of vomiting, but not nausea. The addition of nonpharmacologic interventions such as acustimulation may reduce PDNV. Multimodal analgesia including nonopioid analgesics and ambulatory continuous peripheral nerve blocks are encouraged to achieve adequate postoperative analgesia and reduce opioid induced PDNV.
-
Curr Opin Anaesthesiol · Dec 2011
ReviewConsiderations for patients with obstructive sleep apnea undergoing ambulatory surgery.
The purpose of this article is to discuss the anesthetic considerations of obstructive sleep apnea (OSA) patients undergoing ambulatory surgery and the current recommendations based on recent evidence. ⋯ The recent publications indicated that the majority of OSA patients may be done as ambulatory surgical patients with few adverse events. However, it may not be safe to do patients with severe OSA requiring postoperative narcotics as ambulatory surgical patients.
-
This article will provide a review of mentorship in academic medicine. The review will include definitions and an overview of the evidence supporting the benefits, barriers, and structure of mentorship programmes in academic medicine and anesthesia. Finally, we will identify areas of further research. ⋯ Mentorship has been demonstrated to be an integral part of training and career development in academic medicine and benefits both mentees and mentors. Despite the promotion of mentorship in many academic anesthesia departments, little is published in the available literature supporting mentorship in anesthesia.
-
Curr Opin Anaesthesiol · Dec 2011
ReviewThe potential benefits and the role of cerebral monitoring in carotid endarterectomy.
The benefit of carotid endarterectomy (CEA) in patients with symptomatic severe carotid stenosis is highly dependent on the perioperative stroke rate. Cerebral monitoring plays an important role in reducing the perioperative stroke rate as it allows detection of the main causes of perioperative stroke, being embolism, intraoperative hypoperfusion and postoperative hyperperfusion syndrome. However, some physicians doubt about the benefit of cerebral monitoring and consider it costly and time consuming. The aim of this review is to provide an overview of the available cerebral monitoring modalities and their role in CEA. ⋯ In our opinion, cerebral monitoring during CEA is essential because it provides direct information regarding new neurological deficits, which might otherwise be missed. Intraoperative cerebral monitoring provides immediate feedback to the treating physician allowing prompt correction in tissue handling. Several monitoring modalities are available for cerebral monitoring in CEA, but no single test is comprehensive. Therefore, a combination of several monitoring modalities with each specific strength not only during but also after CEA is recommended to cover all needs and reduce the perioperative stroke rate.
-
Curr Opin Anaesthesiol · Dec 2011
ReviewBlocks for pain management in children undergoing ambulatory surgery.
Data from the USA show that the number of paediatric outpatient procedures has increased by almost 50% during the time period 1996-2006. Despite this increasing trend with regards to ambulatory surgery in children postoperative analgesia is still often suboptimal. The aim of this review is to give an overview of different regional anaesthesia techniques that successfully can be used in paediatric ambulatory surgery. ⋯ Current evidence strongly supports the use of various regional anaesthetic techniques in paediatric outpatient surgery. However, further studies are needed to identify the incidence and severity of pain following different common ambulatory surgical procedures in children as well as comparative prospective randomized trials comparing different regional techniques as well as comparing regional anaesthesia to the best current combination of oral analgesics.