Current opinion in anaesthesiology
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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.
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Curr Opin Anaesthesiol · Dec 2011
ReviewDoes depth of anesthesia monitoring improve postoperative outcomes?
Devices using the electroencephalogram to estimate anesthetic depth have been available since 1996. Despite the use of these monitors for over a decade, there is little agreement among clinicians about the need for or value of depth of anesthesia monitoring. Since the majority of the studies evaluating the impact of depth of anesthesia monitoring on postoperative outcomes have utilized the bispectral index (BIS Covidian), this manuscript will focus on studies with this device. This review will evaluate the evidence that BIS monitoring can improve long-term outcomes. ⋯ There is growing concern that anesthetic management and even specific anesthetic agents may worsen outcomes in high-risk patients. There is, however, no conclusive evidence that depth of anesthesia monitors can improve outcomes and no evidenced-based reasons for anesthesia providers to change their current practice.
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There have been several recent insights in our understanding of how best to provide optimal perioperative anesthesia and analgesia for ambulatory shoulder surgery. This review attempts to distill the advances reported in the past 12-18 months and put them in perspective. ⋯ Following recent findings it is likely that the use of supraclavicular block will become more popular for shoulder surgery. However, further large-scale trials will be needed to definitively prove its advantages over the traditional interscalene block. On the contrary, the precision of ultrasound guidance and the ongoing optimization of postoperative continuous anesthetic infusion regimens continue to improve the performance characteristics of interscalene block.
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Curr Opin Anaesthesiol · Dec 2011
ReviewAssessing recovery after ambulatory anaesthesia, measures of resumption of activities of daily living.
There are several aspects that should be considered when measuring the outcome of ambulatory anaesthesia. Major complications and admission/readmission rate are classical measures. Fast-track eligible, pain, and postoperative nausea and vomiting during the early recovery and time to discharge are commonly reported. There is, however, an increasing interest in quality of recovery in a more protracted perspective taking various aspects of resumption of activities of daily living into account. The aim of the present review is to provide an update around postoperative quality of recovery assessment tools. Resumption of activities of daily living or defined functional capacities back at baseline are measures that provide further insight to the quality of recovery. ⋯ The quality of recovery in a more protracted perspective, resumption of activity of daily living is a measure that needs to be considered in studies of perioperative interventions in ambulatory anaesthesia.