Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Dec 2017
ReviewAre we fully utilizing the functionalities of modern operating room ventilators?
The modern operating room ventilators have become very sophisticated and many of their features are comparable with those of an ICU ventilator. To fully utilize the functionality of modern operating room ventilators, it is important for clinicians to understand in depth the working principle of these ventilators and their functionalities. ⋯ The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.
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Curr Opin Anaesthesiol · Dec 2017
ReviewEnhancing the quality and safety of the perioperative patient.
Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. ⋯ A clear vision of what postoperative recovery should mean for practitioner and patients; careful risk stratification and prophylactic measures to avoid postoperative complications; the judicious use of checklists and other cognitive aids to complement clinical expertise in promoting safety within each local context; and the prompt recognition and rescue of postoperative problems when they occur are all important aspects of a safe perioperative care.
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Curr Opin Anaesthesiol · Dec 2017
ReviewComplications and unplanned admissions in nonoperating room procedures.
The purpose of this article is to review complications and unplanned hospital admissions in patients presenting for ambulatory procedures requiring anesthesia care in the gastrointestinal endoscopy, bronchoscopy, and radiology suites. ⋯ Sedation and anesthesia are required for the increasing number of increasingly complex procedures being undertaken outside the operating suite. Large randomized trials are required to define the optimum sedation drugs, sedation depth and sedation provider.
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Curr Opin Anaesthesiol · Dec 2017
ReviewOptimizing education in difficult airway management: meeting the challenge.
The last 2 decades have seen a vast change in the science and technology of airway management. As a result, there is an increasing need to equip anesthesiologists with the new knowledge and skills for the safe management of a difficult airway. ⋯ There is need for research on difficult airway management and optimized training methods. Research is also required to determine the barriers to adoption of guidelines and strategies to ensure widespread dissemination and implementation of guidelines and best practices for difficult airway management.
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Curr Opin Anaesthesiol · Dec 2017
ReviewThe future of nonoperating room anesthesia in the 21st century: emphasis on quality and safety.
Nonoperating room anesthesia (NORA) has grown from an insignificant percentage of total anesthesia cases into a major percentage of anesthesia workload over the past 30 years. This trend evidences no signs of abating. ⋯ It may be anticipated that in the next decade that NORA cases will constitute over 50% of the number of cases performed with anesthesia involvement. As the last century belonged to invasive surgery, the next century will belong to interventionalists. There is also an increasing national emphasis on quality measurement and metrics reporting. Future anesthesia payment models under Medicare Access and CHIP Reauthorization Act, such as merit-based incentive payment system (MIPS), emphasize various process and outcomes measures. Anesthesiologists will be evaluated based on a composite performance score consisting of four components: quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology.