Current opinion in anaesthesiology
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This review intends to give an overview of developments in anaesthesia residency training. ⋯ Innovations in the field of educational studies have provided us with tools to improve the training of our residents. Portfolio, simulation and quality assurance are among the most prominent developments aimed at creating successful residency programmes. Financial implications of the implementation of educational innovations should, however, be considered.
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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.
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We critically review brain function monitors based on the processed electroencephalogram with regards to signal quality, artefacts and other limitations in clinical performance. ⋯ Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness.
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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.
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Delirium is an acute, potentially life-threatening organ dysfunction with an incidence reported to range from 10-70% after surgery. Postoperative delirium was found to be associated with persisting cognitive deficits, increased physical dependence and institutionalization, and increased mortality. It is a condition particularly relevant to patients with increasing age. ⋯ Delirium may have an impact on patients' outcomes beyond their stay in hospital, depending on preoperative comorbidities. Delirium can be devastating for activity of daily living, cognitive performance and survival. Predisposing factors should be recognized preoperatively; precipitating factors such as preoperative fasting, deep sedation and choice of psychotropic drugs, including sedatives, should be reconsidered. Regular structured delirium screening is the precondition for early detection and treatment. Treatment options include cognitive training programmes, anti-inflammatory measures and antipsychotic drugs.