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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This review is aimed at highlighting the recent developments and opportunities that are likely to impact the anesthesia team of the future. ⋯ The anesthesia team of the future will require the anesthesiologist to provide expertise across the entire domain of perioperative medicine. Meaningful decision support systems rely on accurate data analysis and incorporation of current clinical guidelines and recommendations.