Current opinion in anaesthesiology
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Preoperative anesthesia consultation before major surgery presents opportunities to better document comorbid illness, optimize medical conditions, facilitate referrals to specialists, order specialized investigations, initiate interventions to decrease risk, discuss aspects of perioperative care, and arrange appropriate postoperative care. The goal of this review is to discuss the implications of recent studies that have evaluated the processes-of-care and outcomes related to preoperative anesthesia consultation. ⋯ Preoperative anesthesia consultations have become increasingly common and have shown some clear beneficial effects on perioperative care and outcomes. Further research remains needed to identify efficacious interventions for reducing perioperative risk, measure the prognostic value of specialized preoperative tests, and compare the safety of different models for performing preoperative consultations.
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To provide recent evidence of safety in anesthesia and appraise the role of established tools of safety improvement in anesthesia practice. ⋯ Anesthesia is one of the safest clinical specialties and remains at the top among leaders of patient safety. This review provides evidence for the areas in which further progress can be made, and usefulness of certain tools, such as critical incident reporting, checklists, plan-do-check-act cycles and simulation, can be used for continued improvements.
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Curr Opin Anaesthesiol · Jun 2011
ReviewLocal anesthetic toxicity and lipid resuscitation in pregnancy.
Lipid emulsion has emerged as an effective treatment of local anesthetic-induced cardiac arrest, but its therapeutic application for the obstetric patient requires definition at present. This review discusses clinical reports, relevant laboratory studies, and future directions for the development of an optimal protocol for lipid resuscitation in pregnancy. ⋯ As the obstetric demographic becomes older and more obese, new technologies and strategies can assist in controlling maternal death and major morbidity secondary to anesthesia complications. Lipid resuscitation appears to be an effective treatment for toxicity induced by lipophilic medications and may be useful in treating systemic toxicity in the pregnant patient. Obstetric care providers should be aware of lipid resuscitation and consider its use as described by American Society of Regional Anesthesia and Pain Medicine guidelines.
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Distress in children during hospitalization is increasingly seen as unacceptable and preventable. Surgery and anaesthesia are distressing events for children with maximum stress at induction of anaesthesia. This review aims to report the recent research relevant to reducing this distress in children with a focus on the preoperative period and the impact of this on behaviour at induction and long-term postoperatively. ⋯ New measures of anxiety will facilitate better evaluation of children clinically and better future research. The role of α2-adrenergic agonists in premedication remains unclear. There is still little research, which examines outcomes for techniques for minimizing distress, which are based on specific assessment of the child and family.