Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2011
ReviewAmbulatory anesthesia aspects for tonsillectomy and abrasion in children.
Tonsillectomy is a very common procedure, but with risks or challenges, both for the surgeon and anesthesiologist. Many places have considerable experience and expertise with this procedure, and a lot of clinical studies are continuously being presented. ⋯ Preoperative evaluation should identify increased bleeding risk, potential airway problems, ongoing infection and symptoms of obstructive sleep apnea.Intravenous propofol is most often used for anesthetic induction, although inhalational sevoflurane is a valid alternative. Laryngeal mask airway or endotracheal tube may both be used safely and effectively; the choice will depend upon the routine and experience of the team. Paracetamol and NSAIDs are useful baseline medication for nonopioid multimodal postoperative pain treatment and prophylaxis. Similar with local anesthesia infiltration and dexamethasone medication, although somewhat more disputed. Dexamethasone is also useful for nausea/vomiting prophylaxis, together with ondansetron and also propofol for anesthesia maintenance.
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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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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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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.