Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2013
ReviewAnesthesia for the young child undergoing ambulatory procedures: current concerns regarding harm to the developing brain.
Retrospective studies show that a single anesthesia exposure before age 3 may undermine language acquisition and abstract reasoning, and exposure to two or more anesthetics before age 2 almost doubles the risk of attention-deficit hyperactivity disorder, although in both cases causality has not yet been established.
summary -
To assess the current use of simulation in medical education, specifically, the teaching of the basic sciences to accomplish the goal of improved integration. ⋯ Medical education is undergoing tremendous change. One of the directions of that change is increasing integration of the basic and clinical sciences to improve the efficiency and quality of medical education, and ultimately to improve the patient care. Integration is thought to improve the understanding of basic science conceptual knowledge and to better prepare the learners for clinical practice. Simulation because of its unique effects on learning is currently being successfully used by many institutions as a means to produce that integration through its use in the teaching of the basic sciences. Preliminary data indicate that simulation is an effective tool for basic science education and garners high learner satisfaction.
-
Advances in surgery and anesthesia have allowed for more surgeries to be done on an outpatient basis. A recent important advance entails availability of suitable recovery criteria to capitalize on the benefits of regional anesthesia for ambulatory surgery. With ever-escalating healthcare costs and expectations for faster recovery, anesthesiologists are now challenged to design anesthesia plans focused on Phase I postanesthesia care unit bypass and early facility discharge. Satisfying the recently published WAKE Score criteria upon operating room exit is associated with hospital cost reductions. This review highlights regional anesthesia techniques with focus on outpatient orthopedics. We also discuss 'multimodalities' addressing postoperative nausea and vomiting prophylaxis, perioperative analgesia (including perineural analgesia), and sedation-hypnosis, which are all central to timely recovery using now-available suitable recovery criteria. ⋯ Routine regional anesthesia use, multimodal postoperative nausea and vomiting prophylaxis, multimodal sedation-hypnosis, and multimodal analgesia, along with avoiding volatile agents and short-duration opioids, can lead to both routine Phase 1 postanesthesia care unit bypass and expedited same-day discharge, when using suitable recovery criteria.
-
Curr Opin Anaesthesiol · Dec 2013
ReviewPreanesthesia evaluation for ambulatory surgery: do we make a difference?
Ambulatory surgery is considered low risk; however, both surgery-related and patient-related factors combine to determine the overall risk of a procedure. The preanesthesia evaluation is useful to gather information and determine whether additional testing or medical optimization is necessary prior to surgery with the goal to prevent adverse events and improve outcomes. ⋯ Current literature supports a preanesthesia visit that focuses on individual patient evaluations and patient-directed effective interventions. This is in contrast to the previous routine, protocolized preoperative preparations. The challenge for anesthesiologists lies in understanding both surgery-specific and patient-specific risk factors, and targeting interventions to optimize the outcomes.
-
Changing attitudes toward global health are affecting medical education programs at all levels in the USA and abroad. This review describes some of these changes, and how these affect the educational aspects of US global health programs and anesthesia training in developing countries. ⋯ The past 5 years have brought a new global focus on workforce development and education in anesthesia. Programs need to be supported by all stakeholders and monitored for safety, quality and outcomes.