Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2021
ReviewTelemedicine for preanesthesia evaluation: review of current literature and recommendations for future implementation.
The in-person preanesthesia visit serves multiple purposes including identification and optimization of comorbid conditions as well as patient education. However, it imposes a significant burden on patients and healthcare providers. In this review, we define the scope of telemedicine and present the most up-to-date literature supporting its role for the preanesthesia evaluation. The opportunities and challenges are discussed and approaches to implementation of telemedicine in preanesthesia care are offered. Finally, the future of telemedicine as it pertains to preanesthesia care is examined. ⋯ Telemedicine will continue to expand and its application to the preanesthesia evaluation is a clear example of how technology will revolutionize anesthesia practice. In order for telemedicine to continue to expand in the postpandemic period, steps must be taken to ensure that healthcare facilities and providers keep up with the times.
-
Millions of perioperative crises (e.g. anaphylaxis, cardiac arrest) may occur annually. Critical event debriefing can offer benefits to the individual, team, and system, yet only a fraction of perioperative critical events are debriefed in real-time. This publication aims to review evidence-based best practices for proximal critical event debriefing. ⋯ There is growing literature on how to conduct proximal perioperative critical event debriefing. Evidence-based best practices, as well as a cognitive aid to apply them, may help bridge the gap between theory and clinical practice. In this era of increased attention to burnout and wellness, the consideration of interventions to improve the quality and frequency of critical event debriefing is paramount.
-
Curr Opin Anaesthesiol · Dec 2021
ReviewDischarging select patients without an escort after ambulatory anesthesia: identifying return to baseline function.
The current standard of care requires ambulatory surgical patients to have an escort for discharge. Recent studies have started to challenge this dogma. Modern ultrashort acting anesthetics have minimal psychomotor effects after a couple of hours. Driving simulator performance and psychomotor testing return to baseline as soon as 1 h following propofol sedation. ⋯ A reliable test to document return of function might allow safe discharge without an escort. Currently, there is intense interest in developing reliable, inexpensive, easy to administer psychomotor function testing to improve workplace safety and legally define the effects of drugs on driving impairment. Future studies may be able to adapt this technology and develop a validated test for residual anesthetic impairment.
-
Curr Opin Anaesthesiol · Dec 2021
ReviewPostoperative innovative technology for ambulatory anesthesia and surgery.
To give an overview of the impact of different forms of telehealth that are currently used in ambulatory anesthesia and surgery. Telehealth is applicable during the early recovery and intermediate recovery period (e.g. monitoring of quality of recovery), and as a tool for postoperative check-up during the late recovery phase. ⋯ Telehealth gives many opportunities for postoperative follow-up of ambulatory surgery patients. Clear evidence on the benefits of telehealth in ambulatory surgery is however still sparse. Future research should focus on telehealth for improving quality and safety of postoperative recovery, convincing policymakers for reimbursement encouraging healthcare providers and patients to engage in telehealth.
-
Curr Opin Anaesthesiol · Dec 2021
ReviewScrambler therapy for noncancer neuropathic pain: a focused review.
Therapeutic methods for neuropathic are limited; available drugs can be inadequate or have adverse effects that compromise quality of life. Interest has grown in alternatives to pharmacologic therapy for neuropathic pain. We present a focused review of the literature about the relatively novel noninvasive, nonpharmacologic electrocutaneous nerve stimulation technique called scrambler therapy for treating noncancer neuropathic pain. ⋯ We present the historical perspective, mechanism of action and trial outcomes of scrambler therapy, representing an avenue for managing neuropathic pain without drugs. Well designed phase II/III clinical trials must be conducted to confirm the positive findings reported using scrambler therapy technology. If validated, scrambler therapy could be a game changer.