Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2014
ReviewImportant issues for perioperative systemic antimicrobial prophylaxis in surgery.
Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and important concepts in the field. ⋯ Most frequently, anaesthesiologists administer perioperative antimicrobial prophylaxis. Identification of core principles and harmonization of protocols should facilitate this task and thus help to improve patient safety and to monitor compliance. However, local and regional epidemiology have to be taken into account in order to establish local protocols.
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Curr Opin Anaesthesiol · Aug 2014
ReviewDelirium and sleep disturbances in the intensive care unit: can we do better?
Delirium in the ICU affects as many as 60-80% of mechanically ventilated patients and a smaller but substantial percentage of other critically ill patients. Poor sleep quality has been consistently observed in critically ill patients. These problems are associated with worse ICU outcomes and, in many cases, delirium and poor sleep quality may be related. This review will summarize the recent literature relevant to both the problems and provide a potential pathway toward improvement. ⋯ It is our responsibility to apply the best available, evidence-based medicine to our practice. Adherence to new guidelines for the treatment of pain, agitation, and delirium may be the best pathway toward reducing delirium, improving sleep quality, and improving related outcomes.
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Curr Opin Anaesthesiol · Aug 2014
ReviewAnesthesia in neurologic and psychiatric diseases: is there a 'best anesthesia' for certain diseases?
Patients with diseases affecting the central nervous system present a wide range of clinical manifestations increasing the perioperative risk. The following review focused on recommendations for anaesthesiological management in patients with both neurologic and psychiatric diseases. ⋯ The 'best' anesthesia includes adequate preoperative evaluation of the individual risk, optimization of comorbidities before elective surgery, the use of short-acting anesthetic agents for induction and maintenance of general anesthesia, avoidance of volatile agents and succinylcholine in muscular dystrophy and myopathies.