Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Jun 2014
ReviewQuality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?
Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. ⋯ Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.
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Curr Opin Anaesthesiol · Jun 2014
ReviewNew approaches to obstetric hemorrhage: the postpartum hemorrhage consensus algorithm.
Postpartum hemorrhage is increasingly frequent and a major contributor to maternal morbidity and mortality. Although individual steps, such as coagulation or surgical management, have been reviewed, there is little information on treatment algorithms. ⋯ The algorithm is thought to serve as a template for local adaptation. It will hopefully improve the management of postpartum hemorrhage.
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Curr Opin Anaesthesiol · Jun 2014
ReviewAnesthesia and ventilation strategies in children with asthma: part I - preoperative assessment.
Asthma is a common disease in the pediatric population, and anesthetists are increasingly confronted with asthmatic children undergoing elective surgery. This first of this two-part review provides a brief overview of the current knowledge on the underlying physiology and pathophysiology of asthma and focuses on the preoperative assessment and management in children with asthma. This also includes preoperative strategies to optimize lung function of asthmatic children undergoing surgery. The second part of this review focuses on the immediate perioperative anesthetic management including ventilation strategies. ⋯ To minimize the considerable risk of perioperative respiratory adverse events in asthmatic children, a good understanding of the underlying physiology is vital. Furthermore, a thorough preoperative assessment to identify children who may benefit of an intensified medical treatment thereby minimizing airflow obstruction and bronchial hyperreactivity is the first pillar of a preventive perioperative management of asthmatic children. The second pillar, an individually adjusted anesthesia management aiming to reduce perioperative adverse events, is discussed in the second part of this review.
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Curr Opin Anaesthesiol · Jun 2014
ReviewPerioperative implications of the patient with autonomic dysfunction.
The autonomic nervous system functions to control heart rate, blood pressure, respiratory rate, gastrointestinal motility, hormone release, and body temperature on a second-to-second basis. Here we summarize some of the latest literature on autonomic dysfunction, focusing primarily on the perioperative implications. ⋯ Patients with dysautonomia often have unpredictable and paradoxical physiological responses to various perioperative stimuli. Knowledge of the underlying pathophysiology of their condition is required in order to reduce symptom exacerbation and limit morbidity and mortality during the perioperative period.
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This review highlights the current trends of efficient and safe perioperative pediatric pain therapy in the context of a multimodal pain therapy concept. ⋯ Safe and simple pediatric pain management in the perioperative period combines not only easy to apply and safe stepwise pain therapy itself, but also adequate pain assessment and the implementation of continuous hospital quality improvement strategies.