Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2016
ReviewAn update on pain management for elderly patients undergoing ambulatory surgery.
The aim of this review is to provide an overview of the drugs and techniques used for multimodal postoperative pain management in the older population undergoing surgery in the ambulatory setting. ⋯ The nonopioid analgesic therapies will likely assume an increasingly important role in facilitating the recovery process and improving the satisfaction for elderly ambulatory surgery patients. Strategies to avoid the use of opioids and minimize opioid-related side-effects is an important advance as we expand on the use of ambulatory surgery for the aging population.
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Perioperative prediction models can help to improve personalized patient care by providing individual risk predictions to both patients and providers. However, the scientific literature on prediction model development and validation can be quite technical and challenging to understand. This article aims to provide the necessary insight for clinicians to assess the value of a prediction model that they intend to use in their clinical practice. ⋯ Clinicians can assess the value of a prediction model for their practice by first identifying what the usage of the model will be. Second, they can recognize which performance characteristics are relevant to their assessment of the model. Finally, they need to decide whether the available scientific evidence sufficiently matches their clinical practice to proceed with implementation.
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Curr Opin Anaesthesiol · Dec 2016
ReviewThe future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery.
Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment. ⋯ Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points.